Tag Archives: CMAJ

Mr. William (Bill) Pascal and I were interviewed as part of a qualitative study into Canada’s experience with implementation of electronic health information funded by the Commonwealth Fund and the Canadian Institutes of Health Research. A report summarizing the result of this study was released today in the Canadian Medical Association Journal. Mr. Pascal graciously agreed to author a guest post summarizing his thoughts on the key findings from the study.

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I read with interest the article in the most recent CMAJ on a Qualitative Study of Canada’s Experience with Implementation of Electronic Health Information. The study brings together the collective views of a broad cross- section of key leaders and influencers in the health care sector, all of whom have long experience in developing policies and or delivering care. I have to declare that I was one of these people.

The interpretation by the authors of this study point to many issues which need to be addressed if we are going to be successful as a country with helping to transform our health care system to better serve Canadians. Two observations I thought were particularly timely. The first about creating a provincial clinical information office is intriguing. We have not done a good job in linking Information technology to health care needs and this could help bridge this gap.

The second issue is about the lack of e-Health policies that will guide the implementation of information technologies to better address our pressing health issues in Canada. The development of these policies need to be undertaken now with the participation of all parties; providers, patients, vendors and governments. Some of these will be unique to jurisdictions while others will require national cooperation and dialogue. I thought the list of policy issues highlighted in the Conclusion section was fairly comprehensive. I would be interested in the viewpoints of others on whether this list is comprehensive or others need to be added.

An article published in yesterday’s Canadian Medical Association Journal notes that “confusion and disarray appear to be the only form of national standards in operation within health information record-keeping circles“. Why does this situation exist? Dr. Alexander Jadad, Canada Research Chair in ehealth innovation at the University of Toronto, is quoted as saying, “We don’t really have any federal governance” and “governments have to figure out how to make people comply with these standards“.

While I have been making a similar plea for national standards in various forums, I think that people need to keep in mind the political realities. To start, and perhaps most importantly, healthcare, along with many other matters, is a provincial responsibility. This division of responsibilities drives many aspects of federal / provincial relations and makes it very difficult for the federal government to take an active role in anything related to healthcare. Indeed, Infoway is a creative response to this dilemma that attempts to direct federal money in a manner that respects provincial responsibilities. Any attempt to drive national standards must consider the federated nature of Canadian laws and politics.

So …. where should the leadership about which everyone is yelling about come from? Infoway? Health Canada? A new organization? Or, do we start at the provincial level? Maybe the new eHealth Ontario CEO, Greg Reed, should cease work on provincial eHealth standards and immediately work with Infoway to adapt Pan-Canadian standards instead. As the largest province such a move not only sends a strong signal to other provinces but also creates a market of sufficient size for vendors to come on side.

The article compares the approaches taken by the US and Canadian governments with regard to driving use and adoption of healthcare IT, noting that “For Canadian observers, the US approach is highly instructive — although in many respects, discomfiting.” Points of differentiation noted by the article include:

In the US, “Government leadership is showing results: crucial government-operated elements of the largely privately operated US health care system — such as the $47-billion Veterans Health Administration, which insures 23 million veterans and employs more than 239 000 staff at over 1400 sites — have almost completely implemented electronic health records, which are being made available to patients over the internet.”

With regard to electronic record systems in physician offices, “federal leadership on this issue is providing instrumental, says Leary, who notes that the federal Office of Personnel Management, which manages health plans for millions of federal employees and retirees, is now legally required to ensure its health beneficiaries get access to EHRs.”

“While the US incentives are nationwide and accompanied by tough measures to ensure that physicians actually use the EHRs paid for with government subsidies, Ottawa has left physician implementation to the provinces and has not tracked implementation.”

“With two studies in press comparing Canadian and US approaches to EHRs, Robin Tamblyn with the McGill University Clinical and Health Informatics Research Group says US officials could learn from Canadian mistakes.”

What are your thoughts with regard to the CMAJ observations? Are there things that we are doing right in Canada? Are there some course corrections needed?

Are the views expressed in the article made on behalf of the organization or do they represent Mr. Tessier’s personal opinion? Will these opinions hamper the new CEO’s ability to operate in what is clearly a very political environment?

In an article published yesterday in the Canadian Medical Association Journal (CMAJ) Richard Alvarez, Infoway President, claims that “the year long-freeze on federal funding has compromised plans to rollout initiatives designed to improve physician uptake of electronic records”. He further states in the article that “This will do nothing to improve Canada’s status as an international EHR laggard”.

Nearly a year ago the federal gov’t committed an additional $500M in funding for Infoway as part of larger stimulus package. Commenting on the federal government’s delay in meeting this commitment, Mr. Alvarez states in the article “I don’t want to undermine things by saying that the squeaky wheel always gets oil first, but quite frankly when governments are faced with long waits in certain areas for treatment, that becomes a loud noise. And so, some of the issues that are truly transformational in terms of patient safety, in terms of improving the efficiency, tend to get forgotten.”

I have long been an advocate for continued funding for Canada Health Infoway. What are your views on the matter? What has been the impact on EHR / eHealth progress in Canada from the delay in Infoway funding?